{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:06:42Z","timestamp":1790356002977,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paediatric liver transplantation increasingly incorporates technical variant grafts including living donor liver transplantation (LDLT) to address donor shortages. However, the technical complexity of LDLT and regional outcome variations remain challenging. In settings with such variation and ongoing debate, standardized benchmarks may guide decision-making for broader implementation. This study establishes benchmark cut-off values for paediatric LDLT outcomes to provide a validated framework for quality assessment and safe programme expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An international analysis was conducted of paediatric patients who underwent LDLT at 19 centres between 2019 and 2023. Benchmark cut-off values were derived from \u2018ideal\u2019 patients at seven high-volume institutions, representing the best achievable results under optimal conditions. Surgical complications were graded using the Clavien\u2013Madadi classification, compared against the standard Clavien\u2013Dindo system for accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all, 2665 patients were included, of which 1988 counted as ideal patients. The median recipient age was 10 (interquartile range (i.q.r.) 6\u201326)\u2005months with median weight of 8.0 (i.q.r. 6.6\u201311.9)\u2005kg. Biliary atresia was the most common diagnosis (68.8%), and most recipients (90.9%) received a left lateral segment graft. The 75th percentile of median centre values were used to define the following benchmark cut-off values: hepatic artery thrombosis \u2264 5%, bile leak \u2264 12%, biliary anastomotic stricture \u2264 6%, and 1-year graft loss or mortality \u2264 6%. Higher centre volume was associated with more selective patient inclusion and fewer major (particularly biliary) complications. An inverse correlation between case volume and failure-to-rescue rate highlighted the critical role of multidisciplinary perioperative management. The Clavien\u2013Madadi classification proved superior to the Clavien\u2013Dindo system, which overclassified grade III complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides a framework to guide safe programme expansion, improve surgical quality, and reduce waitlist mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag154","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T11:52:31Z","timestamp":1786189951000},"source":"Crossref","is-referenced-by-count":0,"title":["Benchmarking paediatric living donor liver transplantation for establishing standards to expand access and save lives: retrospective global cohort study"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5654-7043","authenticated-orcid":false,"given":"Zhihao","family":"Li","sequence":"first","affiliation":[{"name":"Department of Surgery and Transplantation, University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Madadi-Sanjani","sequence":"additional","affiliation":[{"name":"Department of Visceral Transplantation, University Medical Centre Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri A","family":"Raptis","sequence":"additional","affiliation":[{"name":"Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasanthakumar","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Institue of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre , Chennai ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9528-8892","authenticated-orcid":false,"given":"Ashwin","family":"Rammohan","sequence":"additional","affiliation":[{"name":"Institue of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre , Chennai ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seisuke","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Organ Transplantation Centre, National Centre for Child Health and Development (NCCHD) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Uchida","sequence":"additional","affiliation":[{"name":"Organ Transplantation Centre, National Centre for Child Health and Development (NCCHD) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Kalici\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute , Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Stefanowicz","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute , Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Goldaracena","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplant Surgery, University Health Network , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-2675","authenticated-orcid":false,"given":"Cornelius J","family":"van Beekum","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix J","family":"Krendl","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Centre for Operative Medicine, Medical University of Innsbruck , Innsbruck ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itsuko Chih-Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryanna N","family":"Domenick","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Kow","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, National University Hospital ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaihang","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Soejima","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Paediatric Surgery, Department of Surgery, Shinshu University School of Medicine , Matsumoto ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katryn N","family":"Furuya","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, School of Medicine and Public Health, University of Wisconsin\u2013Madison , Madison, Wisconsin ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George V","family":"Mazariegos","sequence":"additional","affiliation":[{"name":"Hillman Centre for Paediatric Transplantation, UPMC Children's Hospital of Pittsburgh , Pittsburgh, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5328-7920","authenticated-orcid":false,"given":"Vidyadhar Padmakar","family":"Mali","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, National University Hospital ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Solid Organ Transplantation, Alfred I. DuPont Hospital for Children , Wilmington, Delaware ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim M","family":"Olthoff","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B","family":"Rand","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Leipnitz","sequence":"additional","affiliation":[{"name":"Liver Transplant Unit, University of Auckland , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Long","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Balci","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Bah\u00e7e\u015fehir University Faculty of Medicine , \u0130stanbul ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvan Onur","family":"Kirimker","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ankara University Faculty of Medicine , Ankara ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[{"name":"Department of General Visceral and Transplant Surgery, Eberhard Karls University of T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2619-8639","authenticated-orcid":false,"given":"Stefan","family":"Schneeberger","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Centre for Operative Medicine, Medical University of Innsbruck , Innsbruck ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra L","family":"Sudan","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Department of Surgery, Duke University Medical Centre , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Schmelzle","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta","family":"Herden","sequence":"additional","affiliation":[{"name":"Department of Visceral Transplantation, University Medical Centre Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Visceral Transplantation, University Medical Centre Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blayne A","family":"Sayed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplant Surgery, University Health Network , Toronto, Ontario ,","place":["Canada"]},{"name":"Division of Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky L","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Kowalewski","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute , Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mureo","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Organ Transplantation Centre, National Centre for Child Health and Development (NCCHD) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Rela","sequence":"additional","affiliation":[{"name":"Institue of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre , Chennai ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter C","family":"Broering","sequence":"additional","affiliation":[{"name":"Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Alain","family":"Clavien","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University of Zurich , Zurich ,","place":["Switzerland"]},{"name":"Wyss Zurich Translational Centre, ETH Zurich and University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2026092512323776000_zrag154-B1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1053\/j.sempedsurg.2017.07.014","article-title":"Pediatric liver transplantation","volume":"26","author":"Cuenca","year":"2017","journal-title":"Semin Pediatr Surg"},{"key":"2026092512323776000_zrag154-B2","doi-asserted-by":"crossref","first-page":"e767","DOI":"10.1097\/TXD.0000000000001219","article-title":"Living donor versus deceased donor pediatric liver transplantation: a systematic review and meta-analysis","volume":"7","author":"Barbetta","year":"2021","journal-title":"Transplant 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Hepatol"},{"key":"2026092512323776000_zrag154-B6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/CLD.0000000000000036","article-title":"The current landscape of pediatric living donor liver transplantation in the United States: benefits, challenges, and future directions","volume":"21","author":"Yoeli","year":"2023","journal-title":"Clin Liver Dis"},{"key":"2026092512323776000_zrag154-B7","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/LVT.0000000000000158","article-title":"Insufficient use of technical variant grafts: an unfulfilled promise in pediatric liver transplantation","volume":"29","author":"Sayed","year":"2023","journal-title":"Liver Transpl"},{"key":"2026092512323776000_zrag154-B8","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1097\/LVT.0000000000000614","article-title":"PRO: all pediatric transplant centers should have LDLT as an option","volume":"31","author":"Zielsdorf","year":"2025","journal-title":"Liver 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of the Japanese Liver Transplantation Society","volume":"18","author":"Kasahara","year":"2018","journal-title":"Am J Transpl"},{"key":"2026092512323776000_zrag154-B23","doi-asserted-by":"crossref","first-page":"3435","DOI":"10.3390\/jcm9113435","article-title":"Outcomes of pediatric liver transplantation in Korea using two national registries","volume":"9","author":"Hong","year":"2020","journal-title":"J Clin Med"},{"key":"2026092512323776000_zrag154-B24","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jpedsurg.2009.10.018","article-title":"Low volume is associated with worse patient outcomes for pediatric liver transplant centers","volume":"45","author":"Tracy","year":"2010","journal-title":"J Pediatr Surg"},{"key":"2026092512323776000_zrag154-B25","doi-asserted-by":"crossref","first-page":"e99","DOI":"10.1542\/peds.2014-3016","article-title":"Pediatric liver transplant center volume and the likelihood of 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